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January 29, 2013; 80 (5) Article

Cause-specific mortality of 1-year survivors of subarachnoid hemorrhage

Miikka Korja, Karri Silventoinen, Tiina Laatikainen, Pekka Jousilahti, Veikko Salomaa, Jaakko Kaprio
First published January 9, 2013, DOI: https://doi.org/10.1212/WNL.0b013e31827f0fb5
Miikka Korja
From the Department of Neurosurgery (M.K.), Helsinki University Central Hospital, Helsinki; Population Research Unit (K.S.), Department of Social Research, University of Helsinki; Departments of Chronic Disease Prevention (T.L., P.J., V.S.) and Mental Health and Substance Abuse Services (J.K.), National Institute for Health and Welfare, Helsinki; The Institute of Public Health and Clinical Nutrition (T.L.), University of Eastern Finland, Kuopio; Hospital District of North Karelia (T.L.), Joensuu; Department of Public Health (J.K.), University of Helsinki; and Institute for Molecular Medicine FIMM (J.K.), Helsinki, Finland.
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Karri Silventoinen
From the Department of Neurosurgery (M.K.), Helsinki University Central Hospital, Helsinki; Population Research Unit (K.S.), Department of Social Research, University of Helsinki; Departments of Chronic Disease Prevention (T.L., P.J., V.S.) and Mental Health and Substance Abuse Services (J.K.), National Institute for Health and Welfare, Helsinki; The Institute of Public Health and Clinical Nutrition (T.L.), University of Eastern Finland, Kuopio; Hospital District of North Karelia (T.L.), Joensuu; Department of Public Health (J.K.), University of Helsinki; and Institute for Molecular Medicine FIMM (J.K.), Helsinki, Finland.
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Tiina Laatikainen
From the Department of Neurosurgery (M.K.), Helsinki University Central Hospital, Helsinki; Population Research Unit (K.S.), Department of Social Research, University of Helsinki; Departments of Chronic Disease Prevention (T.L., P.J., V.S.) and Mental Health and Substance Abuse Services (J.K.), National Institute for Health and Welfare, Helsinki; The Institute of Public Health and Clinical Nutrition (T.L.), University of Eastern Finland, Kuopio; Hospital District of North Karelia (T.L.), Joensuu; Department of Public Health (J.K.), University of Helsinki; and Institute for Molecular Medicine FIMM (J.K.), Helsinki, Finland.
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Pekka Jousilahti
From the Department of Neurosurgery (M.K.), Helsinki University Central Hospital, Helsinki; Population Research Unit (K.S.), Department of Social Research, University of Helsinki; Departments of Chronic Disease Prevention (T.L., P.J., V.S.) and Mental Health and Substance Abuse Services (J.K.), National Institute for Health and Welfare, Helsinki; The Institute of Public Health and Clinical Nutrition (T.L.), University of Eastern Finland, Kuopio; Hospital District of North Karelia (T.L.), Joensuu; Department of Public Health (J.K.), University of Helsinki; and Institute for Molecular Medicine FIMM (J.K.), Helsinki, Finland.
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Veikko Salomaa
From the Department of Neurosurgery (M.K.), Helsinki University Central Hospital, Helsinki; Population Research Unit (K.S.), Department of Social Research, University of Helsinki; Departments of Chronic Disease Prevention (T.L., P.J., V.S.) and Mental Health and Substance Abuse Services (J.K.), National Institute for Health and Welfare, Helsinki; The Institute of Public Health and Clinical Nutrition (T.L.), University of Eastern Finland, Kuopio; Hospital District of North Karelia (T.L.), Joensuu; Department of Public Health (J.K.), University of Helsinki; and Institute for Molecular Medicine FIMM (J.K.), Helsinki, Finland.
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Jaakko Kaprio
From the Department of Neurosurgery (M.K.), Helsinki University Central Hospital, Helsinki; Population Research Unit (K.S.), Department of Social Research, University of Helsinki; Departments of Chronic Disease Prevention (T.L., P.J., V.S.) and Mental Health and Substance Abuse Services (J.K.), National Institute for Health and Welfare, Helsinki; The Institute of Public Health and Clinical Nutrition (T.L.), University of Eastern Finland, Kuopio; Hospital District of North Karelia (T.L.), Joensuu; Department of Public Health (J.K.), University of Helsinki; and Institute for Molecular Medicine FIMM (J.K.), Helsinki, Finland.
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Citation
Cause-specific mortality of 1-year survivors of subarachnoid hemorrhage
Miikka Korja, Karri Silventoinen, Tiina Laatikainen, Pekka Jousilahti, Veikko Salomaa, Jaakko Kaprio
Neurology Jan 2013, 80 (5) 481-486; DOI: 10.1212/WNL.0b013e31827f0fb5

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Abstract

Objective: To assess long-term, cause-specific mortality rates and rate ratios of the patients alive at 1 year after subarachnoid hemorrhage (SAH).

Methods: The population-based, prospective, cohort study with a nested case-control design consisted of 64,349 persons (aged 25–74 years at enrollment) who participated in the National FINRISK Study between 1972 and 2007. Four hundred thirty-seven SAH cases, 233 one-year SAH survivors, and their matched intrinsic controls were identified and followed up until the end of 2009 through the nationwide Finnish Causes of Death Register. All-cause mortality rates and rate ratios of the 1-year SAH survivors and controls were the main outcome measures.

Results: Eighty-eight (37.8%) of 233 one-year SAH survivors died during the total follow-up time of 2,487 person-years (median 8.6 years, range 0.1–35.8 years). The 1-year SAH survivors had a hazard ratio of 1.96 (95% confidence interval 1.57–2.47) for death compared with the matched general population with 10 controls for each SAH survivor. One-year SAH survivors had up to 31 additional deaths per 1,000 person-years compared with controls with minimal cerebrovascular risk factors. The higher long-term risk of death among SAH survivors was attributed solely to cerebrovascular diseases, and most important modifiable risk factors for death were smoking, high systolic blood pressure (≥159 mm Hg), and high cholesterol levels (≥7.07 mmol/L).

Conclusion: One-year SAH survivors have excess mortality, which is attributed to an exceptional risk of deadly cerebrovascular events. Aggressive post-SAH cerebrovascular risk factor intervention strategies are highly warranted.

GLOSSARY

BP=
blood pressure;
CI=
confidence interval;
HR=
hazard ratio;
ICD=
International Classification of Diseases;
SAH=
subarachnoid hemorrhage;
SMR=
standardized mortality ratio

Footnotes

  • Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Received June 5, 2012.
  • Accepted September 26, 2012.
  • © 2013 American Academy of Neurology
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